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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107202659
Report Date: 10/20/2023
Date Signed: 10/20/2023 03:34:16 PM


Document Has Been Signed on 10/20/2023 03:34 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:LEONIE HOUSEFACILITY NUMBER:
107202659
ADMINISTRATOR:KENDAKUR, SUNDARIFACILITY TYPE:
740
ADDRESS:2931 CAESAR AVENUETELEPHONE:
(559) 347-9900
CITY:CLOVISSTATE: CAZIP CODE:
93612
CAPACITY:6CENSUS: 5DATE:
10/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Luijean De Castro TIME COMPLETED:
03:50 PM
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On 10/20/2023, Licensing Program Analyst (LPA) M. Flores arrived unannounced to conduct a required annual inspection. LPA met with Care Coordinator, Luijean De Castro and announced the purpose of the visit.

LPA toured the facility inside and out. LPA checked water temperature in resident’s bathroom which read at 106 degrees F. LPA observed fire extinguisher and was last service on 6/08/2023. Kitchen toured, supply of food observed, and food stored properly for perishable and nonperishable. Knives are locked in the kitchen area. Medication is locked next to the kitchen area. LPA observed five bedrooms which were properly furnished, had adequate lighting, and store space. Cleaning supplies were locked in the garage. Smoke detectors and carbon monoxide were checked and operating. Fire extinguisher was charged and was serviced on 6/08/23.

Due to time constraints annual inspection was not completed at this time. No deficiencies and citations were issued at this time. LPA will return to the facility on another date to complete this annual inspection.



Exit interview was conducted with Care Coordinator, Luijean De Castro.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) -24-0610
LICENSING EVALUATOR NAME: Miriam FloresTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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